1/75. The management of non-small-cell lung cancer: a case history.Accurate assessment and treatment of the patient with lung cancer requires a team approach involving respiratory physicians, cardiothoracic surgeons, oncologists and the palliative care team. Adequate staging and assessment of prognostic factors are essential before deciding what treatment is appropriate for an individual patient. Surgery is the mainstay of treatment for early disease. patients with medically inoperable stage 1 (T1, T2, N0) tumours should be considered for radical radiotherapy; additional chemotherapy in early stage disease may offer an additional survival advantage, but its overall role can only be assessed by further clinical trials. In more locally advanced tumours radical radiotherapy has never been formally tested. It is however, often used in patients where the tumour can be encompassed safely within a radiation field. This will depend on total dose and fractionation schedule as well as the volume of tissue irradiated. Neo-adjuvant chemotherapy prolongs survival in these patients. As only a few patients are cured, symptom control and quality of life are usually the most important goals of management and can be achieved by a variety of interventions. It is disappointing that in such a common disease less than 5% of patients are entered into clinical trials. Without such evidence the therapeutic outcomes in NSCLC cannot be improved.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/75. lung cancer associated with pulmonary bulla. case report and review of literature.A few reports have suggested the possible association between lung cancer and bullous disease. We report a surgical case of lung adenocarcinoma located in close proximity to pulmonary bullae. A 48-year-old nonsmoker, asymptomatic male was found to have a pulmonary tumor mass and giant bulla in the right lung. thoracotomy identified a tumor arising from a firm, scarred and contracted area close to the bulla wall. Based on this report and review of other cases in the literature, we emphasize the need for physicians to be aware of the potential development of lung cancer in patients with pulmonary bulla. copyright copyright 1999 S. Karger AG, Basel- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/75. Unusual late extrapulmonary metastasis in osteosarcoma.The major site of metastasis from osteosarcoma is the lung, and over 90% of fatalities in patients with this disease die from pulmonary metastases. Extrapulmonary disease is developing in an increasing proportion of patients, usually after pulmonary metastasis. This study reports three cases of patients with osteosarcoma that metastasized to the brain, mediastinum, intramuscular site, and pelvic cavity. The physician must be aware that extrapulmonary metastases may be present at the time a pulmonary metastasis becomes evident.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/75. tobacco and public health.OBJECTIVES: An interactive program for physicians and surgeons was used to focus their attention on current issues of lung cancer in the united states. The issues examined were the risks for the development of lung cancer in smokers, spouses of smokers, recipients of second-hand or sidestream smoke, and the appropriate workup and treatment of patients with lung cancer. DESIGN: Case presentation with interactive questions and answers. patients: Six patients are presented whose cases demonstrate issues that are relevant and timely to the practice of thoracic surgery and oncology Interventions: Treatment for the five case presentations is used for interactive teaching purposes. CONCLUSIONS: lung cancer is epidemic in the united states, particularly among women at the present time. Physician awareness of the environmental and other factors contributing to the disease should stay current with the population variables that we are seeing in clinical practice.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/75. Metastatic small cell carcinoma to the testis.testicular neoplasms comprise 1% of all malignancies in men, with less than 3% of these malignancies due to metastatic disease. We report a case of a 51-year-old man with a history of left pneumonectomy done 2 years earlier for small cell carcinoma of the lung; the patient came to his primary care physician for routine follow-up. physical examination was significant for a left testicular mass, which on final pathology was diagnosed as metastatic small cell carcinoma.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/75. Primary pulmonary osteogenic sarcoma.A 56-year-old man initially presented to his family physician with tingling in the fingertips of his left hand. A chest radiograph revealed a left upper lobe mass. Local resection found a soft tissue osteogenic sarcoma. This is a report of a rare case of primary pulmonary osteogenic sarcoma.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/75. A case of giant malignant phaeochromocytoma.Malignant phaeochromocytoma is defined as the presence of tumour deposits at sites that are normally devoid of chromaffin cells. We report on a 63-year-old man who had a giant malignant phaeochromocytoma of the right adrenal gland that encased the inferior vena cava. The urinary excretion rates of catecholamines and their metabolites were normal, except for normetanephrine, which was excreted at a higher rate than normal. The tumour was surgically unresectable by laparotomy. Postoperatively, the patient was given a 4-month trial of subcutaneous octreotide and intravenous meta-iodobenzylguanidine I 131. Occult lung secondary tumours were first detected by meta-iodobenzylguanidine scintigraphy after 2 years, and the patient died of bone and lung metastases 1 year later. Because phaeochromocytoma is rare, local experience in managing this disease is limited. This report alerts physicians of the methods of diagnosing and managing surgically unresectable malignant phaeochromocytoma.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/75. government laboratory worker with lung cancer: comparing risks from beryllium, asbestos, and tobacco smoke.occupational medicine physicians are frequently asked to establish cancer causation in patients with both workplace and non-workplace exposures. This is especially difficult in cases involving beryllium for which the data on human carcinogenicity are limited and controversial. In this report we present the case of a 73-year-old former technician at a government research facility who was recently diagnosed with lung cancer. The patient is a former smoker who has worked with both beryllium and asbestos. He was referred to the University of california, san francisco, Occupational and environmental medicine Clinic at San Francisco General Hospital for an evaluation of whether past workplace exposures may have contributed to his current disease. The goal of this paper is to provide an example of the use of data-based risk estimates to determine causation in patients with multiple exposures. To do this, we review the current knowledge of lung cancer risks in former smokers and asbestos workers, and evaluate the controversies surrounding the epidemiologic data linking beryllium and cancer. Based on this information, we estimated that the patient's risk of lung cancer from asbestos was less than his risk from tobacco smoke, whereas his risk from beryllium was approximately equal to his risk from smoking. Based on these estimates, the patient's workplace was considered a probable contributing factor to his development of lung cancer.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/75. A case of poorly differentiated hilar lung adenocarcinoma of an unidentified histological type.The patient was a 74-year-old man, a physician, whose chief complaint was an unproductive cough. The shadow of a mass was seen at the hilum of the left lung, and the mediastinal lymph nodes on both sides were swollen. No histological diagnosis was obtained even after bronchoscopy, including transbronchial needle aspiration biopsy, but large-cell carcinoma of the lung was diagnosed on the basis of ultrasound-guided biopsy of a shadow in the liver suspected of being a metastatic tumor (T2N3M1, Stage IV). Two courses of chemotherapy (CBCDA VDS) failed to gain any improvement, and the pain resulting from recurrent bone metastases was managed mainly by the administration of the best supportive care. The patient was readmitted to the hospital after development of numbness in the right upper extremity followed by complication of pneumonia and heart failure, and he passed away. autopsy revealed a primary hilar lung tumor with a histological diagnosis of poorly differentiated adenocarcinoma.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/75. Pancreatic metastasis of a pleuropulmonary blastoma in an adult.Pleuropulmonary blastoma (PPB) is a rare dysontogenetic tumor that usually develops in the first decade of life and has been recognized as a distinct clinico-pathological entity different from the ordinary pulmonary blastoma of adulthood. Since the tumor grows aggressively and tends to metastasize early, physicians have to be aware of late onset of symptoms and uncommon manifestations. We report a case of PPB in a young adult and its recurrence in the pancreas after primary surgical treatment and adjuvant chemotherapy. Keeping in mind the moderate prognosis of PPB in children, accurate assessment and treatment of PPB require a team approach of oncology, radiology and surgery to establish new therapeutic guidelines in the future.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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